Summary

The aim of this study was to determine which pre-operative risk factors are present in patients with adhesive capsulitis that ultimately require shoulder arthroscopy.

Abstract

Objectives:
Adhesive capsulitis is a poorly understood disease that results in pain and loss of motion in the shoulder joint. The majority of patients are successfully treated conservatively with anti-inflammatory medications, physical therapy and intra-articular injections. However, some recalcitrant cases require arthroscopic surgical release. The aim of this study was to determine which pre-operative risk factors are present in patients with adhesive capsulitis that ultimately require shoulder arthroscopy.

Methods

The National Surgical Quality Improvement Program (NSQIP) was queried from 2006-2016 for all patients undergoing shoulder arthroscopy (n=63,933). All patients with the diagnosis of adhesive capsulitis who required shoulder arthroscopy (n=1641) were analyzed for risk factors compared to the rest of the shoulder arthroscopy population. All patients with an infectious diagnosis were excluded. Student t-test was used to compare groups, univariate and multivariate analyses were performed to identify risk factors, p-values <.00625 were considered significant.

Results

Patients undergoing shoulder arthroscopy for adhesive capsulitis were an average age of 52.3+/-14.6 years, a much larger percentage of the cohort were female, and diabetic compared with the overall shoulder arthroscopy population (58.0% vs 38.8%, p<0.0001) and (14.9% vs 4.6%, p<0.0001). Multivariate analysis demonstrated female sex [OR 2.19 (95% CI: 1.98-2.42); p<0.0001] and diabetes [OR 3.914 (95% CI: 2.83-4.53), p<0.0001] are independent risk factors for undergoing shoulder arthroscopy for adhesive capsulitis. Contrarily, BMI >30 demonstrated a protective effect for patients undergoing shoulder arthroscopy for adhesive capsulitis [OR 0.71 (95% CI: 0.64-0.78), p<0.0001]. In a subset analysis, post-menopausal females (females with age >45) undergoing shoulder arthroscopy, had a significantly higher risk of having a diagnosis of adhesive capsulitis [OR 2.08 (95% CI: 1.89-2.3); p<0.0001].

Conclusions

Female sex and diabetes are significant risk factors for undergoing shoulder arthroscopy for the diagnosis of adhesive capsulitis while obesity (BMI>30) appears to confer a modest protective effect. Understanding the risk factors for adhesive capsulitis that requires shoulder arthroscopy will help orthopedic surgeons more appropriately counsel patients regarding their risk of failing non-operative management.